Category Archives: Group therapy

Clinical Interviewing, Counseling and Psychotherapy Theory and Practice, Group counseling, Group therapy

The Power of Language

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Language is powerful, but sometimes subtle in its influence. Last week in Group class I talked about using psychoeducation to teach people the power of language. As an example, I mentioned the work of Isolina Ricci, and the best post-divorce book ever, Mom’s House, Dad’s House. Ricci tells separated or divorced parents they should change the words they use to refer to their “Ex.” Because “Ex” refers to the former relationship with a romantic partner, it gets to the heart of how people use language to live in the past. Ricci says that we should use “My children’s Mom” or “My child’s Dad” because doing so accurately describes the current relationships. Years ago, I taught her language-based principles in the divorce education courses offered through Families First.

In a class-based group, my students brought up that perhaps we should shift from language that identifies others as “racist” to describing them as “people with racist tendencies.” I was happy my students were grappling with the influence of language. . . and was reminded of my first encounter when I really learned about the power of language and labels.

While in the University of Montana library about 4 decades ago, I recall reading something by Gordon Allport. Given it was so long ago, the memory is surprisingly vivid. Sadly, I can’t conjure up the reference. What I recall is Allport describing something like this:

First, we say, John behaves nervously.

Later, it becomes, John is nervous or anxious.

Eventually, we diagnose John: John has an anxiety disorder.

Then, we diagnose everyone similar to John, and put the disorder first: Anxiety disordered youth, like John, are more likely to. . .

In the end, we’ve inserted a trait-problem in John, without consideration of the context of his initial anxiety or the specific rate of anxiety associated with his so-called “anxiety disorder.” And then we repeat this description until the problem is fully placed inside John (and others) and rarely question that presumption.

This process begs many questions. Is the anxiety really located inside John, as if it were a personality trait or a mental disorder? Where did John’s anxiety originate? If John lived years in a frightening setting, should he be blamed and labeled for having anxiety symptoms? Might it be normal for John to expect that something bad is likely to happen?

The tendency for external observers to see behaviors or symptoms in others, and then insert the behaviors and symptoms inside of those they observe is so ubiquitous that in social/cognitive psychology, they named it the “Fundamental Attribution Error.” But even that language isn’t quite right.

Fundamental attribution error is the tendency to attribute the behaviors of others as representing a “trait” or underlying disposition in them (e.g., racist). Not surprisingly, at the same time, people also tend to attribute their own behaviors to situational factors (e.g., I was more judgmental than usual, because I was a bad mood and hadn’t slept well). To use language more precisely, the fundamental attribution error might be better described as a “common” phenomenon, instead of fundamental. And, of course, that tendency is not always in error. Maybe the better terminology would be “Common misattribution tendency.” Put more simply: We tend to blame others’ behavior on them. How common is that? Very common.

This is all very heady stuff, as is often the case when we dive into constructive language and narrative therapy principles. It tends to be easier for people to change and to believe in the possibility of people changing when we use person-first language and say things like, “engaged in racist behaviors” or “exhibited signs of anxiety,” instead of using firmly constructed attributions.  

Lately, in this blog I’ve been riffing with excerpts from our Clinical Interviewing textbook. Below, I’ve inserted another section from Clinical Interviewing. This excerpt is about using bias-free language in psychological reports.

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Using Bias-Free Language

No matter how careful and sensitive writers try to be, it’s still possible to offend someone. Writing with sensitivity and compassion toward all potential readers is difficult, but mandatory.

The publication manual of the American Psychological Association (APA, 2020, chapter 5) provides guidance regarding bias-free language. Additional details are provided in the APA’s Inclusive Language Guidelines (https://www.apa.org/about/apa/equity-diversity-inclusion/language-guidelines?_ga=2.54630952.2057453815.1669179921-716730077.1592238042).

Avoiding bias and demeaning attitudes is mostly straightforward. In addition to following the APA’s guidance and writing for a multidimensional audience, the best advice we have is to encourage you to conceptualize and write your intake report transparently and collaboratively. This means:

  1. At the beginning and toward the end of your session, speak directly with your client about the content you plan to include in the report.
  2. Rather than surprising clients with a diagnosis, be explicit about your recommended diagnosis and rationale.
  3. Discuss your treatment plan openly with clients. Doing so serves the dual purpose of providing clients with advance information and getting them invested in treatment.
  4. If you’re not clear about how your client would like to be addressed in the report (Mr., Ms., gender identity, ethnicity, etc.), ask directly. Avoid mis-labeling or mis-gendering clients in a psychological report. If you’re working with clients who have physical disabilities, check to see if person-first or disability-first language is preferred.

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I’ve been trying to keep the word-length of these blogs reasonable, and so if you’re interested in a bit more on this topic, this link will give you Practice and Reflection 8.4: “Person-First or Identity-First Language” from, of course, the Clinical Interviewing text.

person-first-or-identify-first-languageDownload
Group counseling, Group therapy, Happiness

Group Counseling: Psychoeducation, More or Less

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Yesterday I kicked off the MOLLI class on “Evidence-Based Happiness Practices” with a psychoeducational lecture. It was standard information about positive psychology, including Seligman’s 1998 inaugural Presidential speech in San Francisco (I was there!), the three-step emotional change trick, three good things, sleep hygiene, savoring, gratitude, forgiveness, and positive distractions. We started and ended with music, and had five-minutes of very small group interactive discussion in the middle. All-in-all, I thought it was a solid start.

This kick-off reminded me of the complex relationship between structured psychoeducation and less-structured or guided interpersonal interactions. In traditional psychoeducational groups (or classes), the emphasis is on information delivery and participant learning. Psychoeducational groups are especially important when participants can benefit from useful information. Most psychoeducational group leaders, also try to integrate some form of interactive or experiential learning into group sessions.  

For me, despite the fact that I often (but not always) like listening to myself and believe I have good information to share, the MOLLI class highlight (during the whole 90 minutes) emerged right after the very small group discussions. I had given a prompt like, “I know it’s awkward to talk about your strengths, but I’d like you to share a nice story about how your own skills or talents usually come out in your relationships with others.” Participants in the room seemed engaged, but the class was hybrid, and so I wasn’t sure of the overall interaction quality. Rather than quickly moving on, I asked if one or two of the participants would share a highlight from their conversation. Silence followed. I waited through it, and finally, an online participant broke the silence with,

“At first we weren’t sure how to start, but by the end, I thought to myself, I want to be friends with these people.”  

These words broke the ice in the room, and several similarly positive comments followed. What I loved about these reactions to their “talk-time” was that participants were responding in exactly the ways I had hoped, they were connecting with each other.   

The balance of psychoeducational content with interpersonal connection is very cool. Sometimes—as in yesterday’s kick-off lecture—we do more psychoeducation and have less interpersonal activity. Other times, we do a five-minute lecture and follow it with 85 minutes of conversation.

One of my takeaways yesterday is to not underestimate the power of psychoeducation to stimulate conversation. Obviously, we use psychoeducation to teach. But when we use it to direct and focus subsequent conversations, we’re also using it to help people to learn from each other.

And here’s a pdf of the ppt from yesterday:

molli-april-2024-jsfDownload
Clinical Interviewing, Group counseling, Group therapy, Writing

Working with Emotions in Counseling and Psychotherapy: Part 2

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In my last post, I reviewed the most basic of all therapeutic emotional responses, the reflection of feeling. As noted yesterday, reflections of feeling are, by definition, neutral . . . and providing a neutral reflection has benefits and liabilities.

For clients who have a history of experiencing negative judgments and oppression, instead of remaining neutral, it may be necessary to be explicitly validating. In Chapter 5 of our Clinical Interviewing textbook, we begin by describing and providing examples of the technique called “Feeling Validation.”

If you’re tracking closely, you’ll recall that a reflection of feeling is on the left side of the “listening continuum” and feeling validation is in the center of the listening continuum. Below, you’ll find information on using feeling validation from the Clinical Interviewing text.

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Directive Listening Skills

Directive listening skills are advanced interviewing techniques that encourage clients to examine and possibly change their thoughts, emotions, and behaviors. Directive listening skills can be used for assessment, exploring client issues, and facilitating insight. They include:

  • Feeling validation
  • Interpretive reflection of feeling
  • Interpretation (psychoanalytic or reframing)
  • Confrontation
  • Immediacy
  • Questions

Directive listening skills place you in an expert role. The therapist’s behaviors in this chapter range from being mostly client centered to mostly therapist centered. Client-centered directives zero in on what the client is already talking about, but take clients deeper. Therapist-centered directives shift clients toward what they’re not yet talking about. Directive listening skills operate on the assumption that clients will benefit from guidance or direction.

Feeling Validation

Reflections of feeling (discussed in Chapter 4) are often confused with feeling validation. The difference is that reflections of feeling are more purely client centered, whereas feeling validation includes your opinion, approval, or validation of client emotions. A feeling validation is an emotion-focused technique that acknowledges and validates your client’s explicit feelings. It’s a message that communicates, “What you’re feeling is a natural or normal emotional response.” Feeling validation is an emotional affirmation.

The difference between reflecting feelings versus validating feelings may seem subtle, but it provides an excellent example of the complexities of skillful interviewing. Skilled interviewers use reflection of feeling as a method to prompt clients to evaluate their own emotions. In contrast, they use feeling validation as a method to support and reassure clients. Feeling validation includes a psychoeducational-authoritative-reassurance component. Novice interviewers may not be aware of the difference.

Psychoanalytic clinicians distinguish between supportive and expressive psychotherapy techniques. Based on this distinction, feeling validation is a supportive technique, and feeling reflection is an expressive technique. Clients usually feel supported and more normal when you validate their emotions. Clients may experience greater stress if you use reflections of feeling to have them examine and judge the validity of their own emotions.

Supportive techniques like feeling validation are outside-in self-esteem boosters. They’re based on the therapist (as an outside authority) saying something like “Your anger in response to being unfairly accused of stealing something seems natural.” One drawback of outside-in self-esteem boosters is that they don’t facilitate self-discovery. The boost that comes from external emotional validation may be temporary and not lead to lasting client change. If clients come to rely on validation of their feelings, they may continue to look outward for external validation.

All approaches to feeling validation give clients the message, “Your feelings are acceptable, and you have permission to feel them.” You might even use feeling validation to suggest to clients that they should be having particular feelings.

Client 1: I’ve been so sad since my mother died. I can’t seem to stop myself from crying. (Client begins sobbing.)

Therapist 1: It’s okay to feel sad about losing your mother. That’s perfectly normal. Crying in here as you talk about it is a natural response.

The preceding exchange involves validation. By openly stating that feeling sad and crying is normal, the therapist takes on an expert or educator role.

Another way to provide feeling validation is through self-disclosure:

Client 2: I get so anxious before taking tests, you wouldn’t believe it! All I can think about is how I’m going to freeze up and forget everything. Then, when I get to class and look at the test, my mind just goes blank.

Therapist 2: I remember feeling the same way about tests.

In this example, the therapist uses self-disclosure to validate the client’s anxiety. Although using self-disclosure to validate feelings can be reassuring, it’s not without risk. Clients may wonder if therapists can be helpful with anxiety symptoms if they have similar anxieties. Self-disclosure can also enhance therapist credibility, as a client may think, “Hmm. If my therapist went through test anxiety too, maybe he’ll understand and be able to help me.” Using self-disclosure to validate client emotions can diminish or enhance therapist credibility—depending on the client and the therapeutic relationship (see Case Example 5.1).

Therapists can also use universality to validate or reassure clients.

Client 3: I always compare myself to everyone else—and I usually come up short. I wonder if I’ll ever feel confident.

Therapist 3: You’re being hard on yourself. I don’t know anyone who feels a complete sense of confidence.

Clients may feel validated when they observe or are informed that nearly everyone else in the world (or universe) feels similar emotions. Yalom provided a personal example:

During my own 600-hour analysis I had a striking personal encounter with the therapeutic factor of universality… I was very much troubled by the fact that, despite my strong positive sentiments [towards my mother], I was beset with death wishes for her, as I stood to inherit part of her estate. My analyst responded simply, “That seems to be the way we’re built.” That artless statement not only offered considerable relief but enabled me to explore my ambivalence in great depth. (Yalom & Leszcz, 2020, p. 7)

Feeling validation is a common technique. People like to have their feelings validated; and, often, counselors like validating their clients’ feelings. However, open support, such as feeling validation, can reduce client exploration of important issues (i.e., clients assume they’re fine if their therapist says so).

Potential effects of feeling validation include:

  • Enhanced rapport
  • Increased or reduced client exploration of the problem or feeling (this could go either direction)
  • Reduction in client anxiety, at least temporarily
  • Enhanced client self-esteem or feelings of normality (perhaps only temporarily)
  • Possible increased client-therapist dependency

In many clinical scenarios, clinicians lead with less directive skills (i.e., Chapter 4) before using more directive skills (i.e., Chapter 5). However, there are some clinical situations where feeling validation or affirmation of clients take priority.

As you think about feeling validation, and all the complexities it can include, consider the following case example.

CASE EXAMPLE 5.1: Struggling to Manage the Impulse to Project My Disability Issues onto a Client

Eddy Fagundo, Ph.D., CRC, CVE, a Senior Manager of Education Content for the American Counseling Association wrote an essay on managing his impulse to project his own issues and lived experiences onto a client. Have you ever worked with someone who reminded you of yourself? Imagine yourself in Dr. Fagundo’s role. Would you be able to manage your impulses to be too comforting and too validating? Although this case is about countertransference, projection, and overidentification with the client, it’s also about appropriately validating self-disclosure and countertransference management.

“Mommy Rosemary, why does Eddy speak Russian?’” was an odd question that had become common for my friends (at age 5-years) to ask my mother . . . in Cuba. What my friends did not know was that I was not speaking Russian; I was speaking Spanish, or so I thought! Growing up, I had speech problems, but was determined to overcome them. I never missed any of my speech therapy appointments and was disciplined in practicing the difficult Spanish rolling Rs in front of the mirror before and after school. I did it! In third grade, I won the best reader in class award. Life was bright. Little did I know, that four years later, I would immigrate to the United States, and learn a new language. But I did this too!

These memories flashed before my eyes when counseling a young Cuban immigrant male with a speech impediment. The client felt defeated, isolated, and had low expectations of himself. I was conflicted; this young man was me as a child. If I could overcome my speech problems, I wanted to tell him: He could too! At the time, I was a new rehabilitation counselor. The situation made me keenly aware of potential projection issues. I knew I could not tell the client what to do. I knew I could not tell him he would be able to succeed, just as I did, because I was no more special than he was.

And so, I consulted my colleagues and supervisor. I focused on being aware of and bracketing my feelings and reactions, and on building a therapeutic relationship. I accepted the client unconditionally and respected his right to be himself without having me project my lived experiences onto him. Instead, I used my lived experiences therapeutically by professionally and appropriately self-disclosing my past struggles with speech problems. Counselor self-disclosure, when done sparingly and effectively, builds trust, fosters empathy, and strengthens the counseling relationship.

Today, the client is fully fluent in what some would argue to be the true universal language: mathematics. He holds a doctorate in mathematics, the speech impediments are improved, and he lives a fulfilling life. Even today, I wonder how different the outcome would have been had I not had the self-awareness and professional support to counter my projection impulses.

We will encounter clients similar to us in ways that make us struggle to avoid projecting our own lived experiences onto them. We need to identify those clients, but to do so, we must first ask, “Who am I, and who is standing beside me to support me in this journey of self-discovery?”

[End of Case Example 5.1]

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Our Clinical Interviewing text also includes specific learning activities. If you want to check out a learning activity designed to add nuance to your feeling (emotional) vocabulary, check out this handout:

practice-and-reflection-emotionsDownload
Clinical Interviewing, Group counseling, Group therapy, Happiness, Writing

Working with Emotions in Counseling and Psychotherapy – Part 1

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We’ve been talking about emotions in our Group Counseling course at the University of Montana. Even though focusing on emotions has grown immensely in popularity within contemporary counseling and psychotherapy, some students seem to be missing a few basics. Last week, when I took time to talk about the differences between (a) reflection of feeling, (b) interpretive reflection of feeling, and (c) feeling validation most of the students found the information useful. Consequently, I’m including here (and in a following blog post or two) excerpts from the latest edition of our Clinical Interviewing textbook. https://www.wiley.com/en-us/Clinical+Interviewing%2C+7th+Edition-p-9781119981985

The foundation that guides how clinicians respond to clients is described in our “Listening Continuum” (see below).

the-listening-continuum-in-three-partsDownload

This excerpt is from the section in Chapter 4 on Reflection of Feeling.  

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Reflection of Feeling (aka Empathy)

The primary purpose of a reflection of feeling is to let clients know, through an emotionally focused paraphrase, that you’re tuned in to their emotional state. Nondirective reflections of feeling encourage further emotional expression. Consider the following example of a 15-year-old male (he/him) talking about his teacher:

Client: That teacher pissed me off big time when she accused me of stealing her phone. I wanted to punch her.

Counselor: You were pretty pissed off.

Client: Damn right.

In this example, the feeling reflection focuses only on what the client clearly articulated. This is the rule for nondirective feeling reflections: Restate or reflect only the emotional content that you clearly heard the client say. No probing, interpreting, or speculation are included. Although we might guess at underlying dynamics contributing to this boy’s fury, a nondirective feeling reflection focuses on obvious emotions.

Emotions are personal. Every attempt to reflect feelings is a move toward closeness or intimacy. Some clients who don’t want relational connection with you may react negatively to reflections of feeling. You can minimize negative reactions to reflections of feeling by phrasing them tentatively, especially during an initial interview:

When using reflection to encourage continued personal exploration, which is the broad goal of reflective listening, it is often useful to understate slightly what the person has offered. This is particularly so when emotional content is involved. (W. R. Miller & Rollnick, 2013, p. 59)

Emotional accuracy is your ultimate goal. However, if you miss the emotional target, it’s better to miss with an understatement than an overstatement. If you overstate emotional intensity, clients will often backtrack or deny their feelings. As we’ll discuss in Chapter 12, there’s a proper time to intentionally overstate client emotions. Generally, however, you should aim for accuracy while proceeding tentatively and understating rather than overstating clients’ emotions. Rogers (1961) would sometimes use clarification with clients after giving a reflection of feeling (e.g., “I’m hearing sadness and pain in your voice… am I getting that right?”).

If you understate a reflection of feeling, your client may correct you.

Client: That teacher pissed me off big time when she accused me of stealing her watch. I wanted to punch her.

Counselor: Seems like you were a little irritated about that. Is that right?

Client: Irritated? Fuck no—I was pissed.

Counselor: You were way more than irritated. You were pissed.

In this example, a stronger emotional descriptor is better because the client expressed more than irritation. However, any adverse effect of “missing” the emotion is minimized because the counselor phrased the reflection tentatively with “Seems like…” and then added a clarifying question at the end. Then, perhaps most important, when the client corrected the counselor, the counselor repaired the reflection to fit with the client’s emotional experience. From a psychoanalytic perspective, the repairing of emotional mirroring or empathy might be the most therapeutic part of listening (Kohut, 1984; see Practice and Reflection 4.3 to practice emotional responses to clients).

Reflections of feeling are often labeled as empathy. If only empathy were so simple. As Clark noted, “Rogers . . . was appalled by this . . . as the rich and nuanced process of empathy was reduced to trivial and repetitive expressions of a therapist identifying a client’s feelings” (p. 23). As we move forward through this chapter and other content on more directive interviewer responses, remember that empathy should be woven into nearly every therapist utterance, including confrontation, advice, and behavioral homework (Clark, 2023). 

With clients, mental health professionals engage in emotional clarification, exploration, validation, and education. Your role varies depending on your clients’ needs and situation. As a technique, reflection of feeling aids clients in clarifying and exploring their emotions.  For this chapter and reflection of feeling, the best path is a tentative one, wherein you function as a mirror to help clients experience and articulate their emotions with greater clarity. Doing so can serve to help clients explore and gain greater understanding of their emotional worlds. To accomplish your interviewing goals, you don’t need to know everything about the academic and popular debates over emotions; instead, you partner with clients to deepen your mutual understanding of the emotional experiences. 

[Several pages of the text are skipped here]

Gender, Culture, and Emotion

Imagine you’re in an initial clinical interview with a Latino (he/him) cisgender male husband and father. He looks unhappy and your impression is that he’s angry about his wife’s employment outside the home. You’re aware that some Latine/x people have traditional ideas about male and female family roles. This knowledge provides you with a foundation for using a reflection of feeling to focus on his anger:

I’m getting the sense that you’re a little angry about your wife deciding to go back to work.

He responds,

Nah. She can do whatever she wants.

You hear his words. He seems to be empowering his wife to do as she pleases. But his voice is laden with annoyance. This leads you to try again to connect with him on a deeper level. You say,

Right. But I hear a little annoyance in your voice.

This reflection of feeling prompts an emotional response, but not the one you hoped for.

Sure. You’re right. I am annoyed. I’m fucking annoyed with you and the fact that you’re not listening to me and keep focusing on all this feelings shit.

This is a dreaded scenario for many clinicians. You take a risk to reflect what seems like an obvious emotion, and you get hostility in return. Your emotional sensitivity and effort at empathy backfires. The client moves to a defensive and aggressive place, and a relationship rupture occurs (see Chapter 7 for more on dealing with relationship ruptures).

It’s tempting to use culture and gender to explain this client’s negative reaction to your reflection of feeling. But it’s not that simple.

Although culture, gender, race, and other broad classification-based variables can sometimes predict whether specific clients will be comfortable with emotional expression, individual client differences are probably more substantial determinants. Comfort in expressing emotion is often a function of whether the client comes from a family-neighborhood-cultural context where emotional disclosure was a norm. For example, Knight (2014) reported that Black and Latino males who were unlikely to disclose to their peers attributed this tendency to their experiences living in violent communities. These young men learned that emotional expression and trusting others were bad ideas in their neighborhoods. Conversely, emotional disclosure is more likely in the comfort range of Black and Latine/x males raised in safer communities. This makes good common sense: Whether clients perceive you as safe to talk with about emotional concerns probably has more to do with their backgrounds and past experiences than you.

Overall, it’s likely that clients’ willingness to tolerate feeling reflections is based on a mix of their cultural, gender, and individual experiences. Although biogenetics may be involved too, how people handle emotions is largely socialized (McDermott et al., 2019). If you have reason to suspect that your client is socialized to be uncomfortable with emotions, you should avoid emotionally specific words. Examples of emotionally specific words include angry, sad, scared, and guilty.

Instead of emotionally specific words, you can substitute words that are emotionally vague (and less intense). Later, as trust develops, you might be able to use specific emotional words. Consider the following phrases:

  • You found that frustrating.
  • It seems like that bothered you a bit.
  • It’s a little upsetting to think about that.

Practice and Reflection 4.4 lists examples of emotionally vague words you might use instead of emotionally specific words.

PRACTICE AND REFLECTION 4.4: USING VAGUE AND EMOTIONALLY SAFE WORDS

Emotionally Specific WordsSubstitute (Safer) Words
AngryFrustrated, upset, bothered, annoyed
SadDown, bad, unlucky, “that sucked”
ScaredBothered, “didn’t need that,” “felt like leaving”
GuiltyBad, sorry, unfortunate, “bad shit”

Note: These words may work as substitutes for more emotionally specific words, but they also may not. It will be more effective for you to work with your classmates or in your work setting to generate less emotionally threatening words and phrases that are culturally and locally specific.

[End of Practice and Reflection 4.4]

Gender diverse clients may be emotionally sensitive in ways different than clients on the gender binary. Due to their neutrality, reflections of feeling—even when accurate—can be activating if clients are sensing you’re coming from a place of judgment. Consider the following:

Counselor: You said your family is rejecting your sexual identity, and you’re feeling terribly sad about that.

Client: Wouldn’t you?

When clients have a substantial history of interpersonal rejection, emotional invalidation, and/or oppression, neutral comments from clinicians can be perceived as judgmental. In this exchange, the counselor uses an accurate simple paraphrase along, with an emotional reflection, but the client feels judged and responds defensively. Given the client’s history, feeling judged in response to neutral reflections is natural. What the client needs (to feel connected and supported) is a response that’s explicitly affirming or validating (Alessi et al., 2019). In this case, at least until rapport is established, rather than a feeling reflection, the client would likely react better to a feeling validation (“Your sadness in response to your family’s rejection of your sexual identity seems totally normal”; see Chapter 5 for information on feeling validations). 

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Thanks for reading. In the coming week, there will be additional posts on the basics and nuances of working with emotions in counseling and psychotherapy.

Group counseling, Group therapy, Happiness

Co-Leader Conflict . . . Vulnerability . . . and Giving Each Other (and Ourselves) Grace

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Group this week was chaotic, great, and disconcerting. As the leader-instructor, I felt perhaps I didn’t get the students prepared enough to run their in-class discussion and color groups. I worried that now we’ve got too much experiencing and not enough educational content.

These feelings and thoughts are familiar; maybe they’re familiar to other educators. To learn, students need experiences, but they also need knowledge, information, and educational content to put experiences in context. They also need external feedback, to go along with the internal feedback process in which they naturally engage. How hard is it to hit the sweet spot? Very hard!

While observing one group, I noticed conflict emerging between co-leaders. I didn’t intervene. During their self-evaluation process, the leaders acknowledged their tension. My response? I normalized their experience of co-leader conflict and the challenges of co-leader conflict management.

Later, while debriefing the various group experiences with the whole class, I spontaneously began speaking about group leader conflict. Words came out of my mouth in advance of a clear mental formulation of what I wanted to say.

“Group co-leader conflict will occur. Sometimes your co-leader will go a different direction. You’ll be watching and wondering, ‘What’s going on here?’ You may have a negative reaction. You may feel critical and annoyed. When this happens, we need to give each other grace.”

Another theme bubbling up this week involved vulnerability. The group leaders feel vulnerable and on-the-spot for obvious reasons; I expected that. What I’ve been less prepared for is the vulnerability students felt as group members who were prompted to share “happy” and “meaningful” songs. Here’s their group leadership assignment:

color-group-prep-for-positive-psychology-iDownload

Some students seemed sensitive to perceived coercion, and the related expectation that they were obligated to be vulnerable. I got enough takeaway emails about vulnerability that I’m sharing a few of my responses (I’m not sharing the emails from the students; I’m sharing my email responses)  

Emails on Vulnerability

I’m glad to hear the music activity felt connecting for you with your group. It’s interesting how music might seem like a “light” topic, but it certainly can get emotional and vulnerable, sometimes very quickly.

Thanks for sharing your reactions from your color group experience. I’ve heard similar reactions from others. I too, found myself surprised that some members felt the activity involved vulnerability . . . but then I remembered several things, not the least of which is the emotional power of music and the fact that talking about happiness nearly always, at some point, elicits sadness and vulnerability.

Your comments about the diverse reactions to the music assignment reminds me of a point I want to make in class tomorrow. The point being: When we talk about happiness, the emotional reaction is often the opposite! Initially, I felt surprised that some groups felt the assignment was pretty vulnerable, but then I thought, of course! Sharing anything feels vulnerable. . . and music is a powerful emotional activator.

Thanks for sharing your thoughts/reactions from your Color Group. Noticing and appreciating others’ discomfort is so important, partly because it involves empathy, but also because what causes some people discomfort may not even be a blip for others, including you. It IS a great thing to be mindful about.

Reading and responding to student emails is helping me be more thoughtful and accepting of their experiences. Although their experiences naturally activate my memories about my grad school group experiences, more importantly, reading about their experiences helps me move past my own memories and my own narrow lived experiences. My students are giving me a chance to have greater appreciation for the wide range of simple and complex factors that activate their vulnerabilities. For me, that’s one (of many) lessons from this week: My surprise regarding students’ feeling vulnerable is countertransference. As countertransference, it’s a good thing to notice. But the point is to give myself grace around my countertransference, while nurturing and growing my ability to move around my surprise and seek deeper understanding of my students’ experiences . . . just as I hope they will do with their clients.  

Counseling and Psychotherapy Theory and Practice, Group counseling, Group therapy, Personal Reflections

Storming: My Favorite Group Stage (at least for today)

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In group class, we’re covering content related to group stage called “Storming.” The Coreys’, who’ve written about and led many groups, call this the “Transition” stage. During the storming or transition stage, group members start to push against or question group norms and/or the group leader’s authority. Not to be trite, but like roses, no matter what name it, the smell and tension of storming feels the same.

I’ve been waiting and watching for storming to emerge within my class. I know group process unfolds during class groups, just as it unfolds in psychoeducational, counseling, and psychotherapy groups. I thought I might ignite storming, by asking my counseling graduate students to focus on positive psychology. I did get a little push-back from students who emailed me about their “mixed” feelings about positive psychology. My response was to share that I also hold mixed feelings about positive psychology, along with mixed feelings about psychoanalytic theory, behavioral theory, CBT, feminist theory, acceptance and commitment therapy, and every other theory or approach I can think of.

This past week an ever-so-minor edge of a storm found its way into class. After class started, one student expressed negative feelings about a reading I’d assigned, noting that she thought the article was “shaming” to mandated clients. As often occurs with storming, I had an immediate and complex emotional and impulse-ridden response. Rather than acting on my emotions or defending the reading, I managed to welcome the critique. When I say “managed” I mean to communicate that IMHO, welcoming critiques is not easy, and maybe not natural. A few minutes later, I acknowledged that although I wished everyone would love all the class readings, I also wanted people to feel they had permission to not love the readings and speak openly about their opinions. Later that evening, I received an email takeaway from the student who didn’t like the reading. As you may recall, one of my group class assignments is for students to email me two takeaways in the days following class. Because she expressed what I want to communicate better than I can, here’s her email (shared with her permission).

Hey John,

My biggest takeaway from today was watching your modeling of working with storming, both with myself and [with another student]. The way that you allowed for expression of our feelings, were vulnerable with your own, and then used the material to create more conversations, norms, etc., was really helpful to see. I also want to share on this topic that when my oldest kiddo and I were talking this morning about what our days were looking like, I was talking to her about my feelings about an article we read for class that I didn’t agree with, and that I was going to bring it up in class. And her response was, “You’re going to tell your professor that?!?!” She was shocked that I felt like I could say that in class, and I wanted to thank you for creating a space where I felt like that was alright.

My other takeaway is your quote from class today, “We want to give people the chance to be interesting.” I think there are so few opportunities that people have to be seen and heard by others in a way that is meaningful. Coupled with the big, sort of inherent opportunity as a group leader to take up ‘too much space,’ your advice feels like a really important nugget that I want to take with me into leading groups in the future.

What I love best about this email (and I love a lot of it) is my student’s anecdote about her daughter’s reaction: “You’re going to tell your professor that?!?!” And what I love best about that is—consistent with other conversations we’ve been having in class—we should not run groups like cults. As leaders, professors, administrators, clergy, and politicians, we need to be open to independence of thought and listen to unique perspectives. What I think is not the truth and what I value is not necessarily the correct moral philosophy for everyone.

Today. . . I am very happy to have handled a little storming with acceptance and openness. Tomorrow may be different. But for today, I get to feel the good feelings of being able to live my best group leader values—even if it didn’t involve me being right about anything.  

Group counseling, Group therapy

Group Leadership: Talking More and Talking Less

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Teaching Group: Talking More and Talking Less

Lately, when presenting, I find myself naturally saying, “I’m a university professor. That means I can talk all day long.”

But because I know that me talking too much is a bad idea, I complement my university professor disclosure with, “I’d rather have a conversation, so please interrupt me with comments, questions, and reactions.” I also try to offer an experiential learning or reflection activity.

In group class, I have so many stories to tell that I can feel my already prodigious talking urges escalate. I could unleash my breathless wordy-self for three straight hours. The students would leave having been entertained (I am funny), and with a bit of knowledge, but without skills for running counseling groups.

All this circles back to my plan to make the course as experiential as possible. I want students to feel the feelings of being in the group facilitator chair. Some of those feelings will be nerves, but it’s better for students to feel more nerves in group class, and fewer nerves when they’re leading real groups.

We recently hit Day 1 of the transformative experiential chaos.  

I know from the takeaways that students write me every week that there were nerves. In a fishbowl group, I asked members to share one positive interpersonal quality. As a second and optional prompt, I suggested they could also share one less positive interpersonal quality.

My goal was for us to briefly look at and talk about Yalom’s concept of interpersonal learning.

I shared first (to demo leader self-disclosure and modeling); I intentionally described a positive and less positive interpersonal quality. The first student to disclose felt instant awareness of the past, present, and future. Afterward, she described feeling a burden to follow my lead, anxiety in the moment, along with instant recognition that she was about to become a role model. She shared both (a positive and less positive interpersonal quality). Everyone followed her lead. Some members felt more anxiety when sharing the positive qualities; for others, it was the opposite.

One takeaway involved the speed and power of norm-setting. I’m reminded of the social psych compliance research. More or less, people consciously or less consciously feel the “norm” and comply. The corollary takeaway is that when leaders set the norm, we need to do so carefully so as to not imply everyone needs to fall in line.

Jumping ahead, the next week I discussed Kelman’s theory of group cohesion. Although I absolutely love Yalom’s definition (“Cohesion is the attraction of the group for its members”), Kelman’s theory is complementary, and was introduced to my be my 1975 Mount Hood Community College football coach. Kelman (and my coach) identified three phases: Compliance, Identification, and Internalization. After talking about Kelman’s theory, several students reflected in their email takeaways about the nature of cult groups. . . and how compliance can become leader-driven. Wow. So good.

In response to one student’s takeaway, part of my email included the following:

“For groups to be safe, IMHO, that also means freedom; freedom to have dissenting beliefs and different experiences and different values. The “internalization” shouldn’t be too tight, or it does feel like a cult. I’m not sure I have great answers about safeguards to the abuse of group processes, and so you’ve given me things to chew on as well.”

Maybe the right recipe is for there to be leader-guided modeling, combined with clear rules and norms that support independent thinking and personal freedom. This is a VERY tricky balance. It’s easy for leaders (including me) to get too enamored with the sound of our own voices and the rightness of our own values.

This brings me back to reflecting on how much leaders should talk and how much leaders should listen. Of course, this depends on the type of group: psychoeducational groups involve more group leader talking. In contrast, counseling groups—even discussion-based groups or support groups—benefit from the group talking more and the leader talking less. This has been a repeated epiphany for students and for me: being aware of the need to balance leader-talk and leader modeling with group member talk and group member modeling.

For the next class, I gave everyone an electronic copy of a long list of 23 group counseling skills to integrate into one of their experiential groups. Here’s the list:

basic-group-counseling-responses-2024Download
Group counseling, Group therapy

Teaching Group: The Case of Zoey and Adlerian Theory

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Group class is rolling downstream so fast that I feel I’m riding down Niagara Falls in a barrel. Well, that might be me being dramatic. My personal drama partly explains why I’m so late blogging about week 2 of group class.

Much of the focus of week 2 was on Yalom’s 11 therapeutic factors. I think they’re subtle, powerful, and sneaky insightful. When I teach the 11 factors, I try to give as many concrete examples as possible. Here’s one:

I got asked to run two in-school groups for 5th graders. I had twins in group (one in each group). These were difficult groups. I had let the principal assign the members. I know, bad idea, especially because I knew better; pre-group screening was both optimal and ethical. I share this story because it’s a good one, but also because I can acknowledge that I make mistakes and am still a work in progress.

The twins identified themselves as evil and good. They seemed to be living up to their self-proclaimed identities. The evil twin (let’s call her Zoey) got “removed” from the first three group meetings. My rule was to remove students and send them back to class if they violated the group rules. Zoey was intermittently making aggressive physical contact. She ripped up some “Disney cards” I had given all the students, and threw them at me. In each case, I just said, “Zoey, you’ve broken a rule and you need to go back to your class.” There were small protests, but she would eventually stand up, leave group and go back to class.

The other part of the rule was to let anyone who had been removed from group back in group if they presented me with an apology note. Zoey became an efficient apology note writer.

Dear Mr. Jhon,

I am sorry I pushed Amber. I won’t push Amber again. Can I come back to group?

Zoey

At the beginning of session 4, as Zoey walking into group, I impulsively said something like, “Zoey! You are in so much trouble. You are in so much trouble that you have to serve our group treats today.” Zoey stared at me, sat down, and began her new journey to becoming a very nice, polite, and wonderful group member.

I repeated my “You’re in so much trouble Zoey” opening the next week. And the next. Zoey never again pushed anyone, she didn’t argue, she became shockingly pleasant and cooperative.

At the end of group, Zoey wrote me a “Good bye” note. It read:

Dr. Mr. Jhon,

I had fun in group. Thank you for coming to our school. I will miss you.

Zoey

With this story (and many others), we get a chance to glimpse the complexities of human behavior. Zoey’s story also gives us a chance to apply counseling theory to group dynamics. The theory that comes to mind for Zoey is related to Dreikurs’ and Adler’s ideas about the 4 psychological goals of children’s misbehavior. You can read about why children (and adults) misbehave here: https://johnsommersflanagan.com/2017/06/10/why-children-misbehave-the-adlerian-perspective/. But in group, the focus is less on the 4 goals, and more on the two overarching factors that will, most of the time, mitigate and sometimes eliminate the misbehavior. What are these overarching factors?

A sense of belonging

Feeling useful

With Zoey, I think she suddenly felt useful. She also got proactive attention in a sort of sarcastic message of her being in trouble. I thought the “You’re in big trouble” part was pretty clever. But the more important part was to give her a job. . . to help her feel useful . . . and along with that came belonging.

In some ways, the Zoey intervention was an individual intervention that helped her function in a group. That was important because Zoey had never been successful in any group. She hadn’t been on a team, in a choir, and she rarely succeeded in making it through the school day without an interpersonal incident. “Graduating” from our group, was a big deal for Zoey.

Beyond the Adlerian principles, the evil twin scenario includes glimpses of Yalom’s therapeutic factors. Can you identify which ones? Here’s the list:

  1. Instillation of hope
  2. Universality
  3. Imparting information
  4. Altruism
  5. The corrective recapitulation of the family group
  6. Development of socializing techniques
  7. Imitative behavior
  8. Interpersonal learning
  9. Group cohesiveness
  10. Catharsis
  11. Existential factors

I’m heading into class momentarily, and so I’ll add the following observation quickly.

At this point, my group students still think I know what I’m doing. We’ve engaged in several whole group and subgroup (fishbowl) group activities where I’m the leader. One student referred to me as “smooth.” As much as I like that compliment, I also recognize that me being smooth is completely related to the students being engaged and cooperative. Maybe we’re still in the honeymoon phase of our group class. Maybe the storming is yet to come? Maybe everyone feels they belong, and that they’re useful. I do work at helping everyone feel belonging and usefulness.

As the instructor, I know that referencing that storming can happen and articulating, in advance, how I usually address storming, can make storming less likely. None of the students are especially keen to be the first stormers. Everyone (probably) knows that no matter the nature and content of the storming, I will try to meet it with acceptance and an opportunity for the stormer to “tell us more” while taking responsibility for their feelings. Nevertheless, sooner or later, I will want to prompt them to storm, rather than hold in feelings of discontent.

One last thought. I am not always smooth. I am not always competent. I am not always emotionally centered and ready to be a good group counselor. Given those realities, I’m also aware that it will be even more important (than being smooth) for me to acknowledge my mistakes and be vulnerable enough for students to accept me as a role model who isn’t just interested in being smooth, but is also interested in being vulnerable.

Thanks for reading! More to come soon. Here are the Week 2 powerpoints:

group-class-2-2024Download

John

Group therapy

Teaching Group Counseling: Class 1

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I feel sorry for Mick Jagger. In that one song he lamented over and over about not getting no satisfaction. If he would just have asked me, I could have helped. I would have told him exactly how to get satisfaction. I’d have said, “Hey Mick. All you have to do to get satisfaction is to teach a course on group counseling to about 34 fantastic counseling students from the University of Montana, along with having a couple of teaching assistants.”

That’s it, Mick. Even you can achieve satisfaction. Getting satisfaction from teaching group counseling might even inspire you to write a new song titled “So Much Satisfaction.” Here are some lyrics for you to consider (no need to thank me Mick):

I can’t stop getting, satisfaction,

cause I tried, and I tried, and I tried, and I tried

I keep getting so, much satisfaction. . . satisfaction. . . satisfaction.

No doubt all you readers are now on the edges of your seats and experiencing bated breath while waiting to hear how group class #1 went. Well, here’s the answer. Great. Awesome. Exciting. Fun. And satisfying. . . so satisfying.

During our introduction activities, everyone was engaged, funny, profound, humble, and always interesting. During my lecture time, I talked about group types and made my “we need to stretch ourselves to listen with acceptance to everyone” speech. One response to my little speech was genuine concern about being able to be accepting with clients who, in their presentation, are harsh, judgmental, and politically and socially extreme in their values. This was a challenging comment/question, because of how incredibly hard it is to listen with compassion and empathy when someone is expressing extremely unkind and judgmental thoughts and beliefs.

Had I been a better group counselor in the moment, what I might have done was to push the question/comment out to the group. On the other hand, I knew that I was probably the one in the room with the most experiences of this type. I was immediately (in Class #1) thrown into an Irv Yalom-esque group leader dilemma. Should I respond with my thoughts. . . or should I deflect the question/scenario to the group.

Yalom also emphasizes that group leaders are, by default, the group role-models and norm-setters. That being the case (and given that this is a graduate course with 36 “group participants”), I chose to throw myself and a couple stories into my response.

The stories—working with parents who insisted on not accepting their child’s sexuality/gender and working with fathers who, not infrequently, would call me variations on the theme of “pansy-ass”—emphasized the strategy of listening first, of thanking parents, clients, students, for their openness, and then highlighting the truth that we cannot lead with education (no matter how much we think it’s needed). Instead, we listen with acceptance and empathy until there’s an opportunity to “broaden” the parent/client/student’s perspective.

I’ve put the word “broaden” in quotations because it’s related to what I want to share next: The Weekly Class Takeaway Email Assignment.

The Takeaway Assignment

This past year, I’ve been using the weekly takeaways assignment to give me a clearer sense of what the students are experiencing in our classes together. For this assignment, students send me, within 5 days of the lecture/class time, an email describing their top two class takeaways. The takeaways assignment also allows me to evade the possibility of an AI generated response.

Typically, and this was the case with week one of the group class, student responses are consistent with what I thought they would takeaway. However, the most exciting part of reading the takeaways is when students weave their own personalized perceptions into their responses; this gives me a glimpse not only of what they’re thinking, but how the content I’m presenting on is being received and interpreted by students. I especially like it when students have reflections that surprise me, or include content that I had not expected, because . . . that’s when the learning goes both directions. 

In their takeaways, a couple students used the word “broaden” to discuss their perceptions of my response to the “How can we handle very judgmental clients?” question. I hadn’t remembered using the word, but it felt perfect—especially in the context of group counseling. One of the big goals of group counseling—again, I’m channeling Yalom—is to hear, see, feel, and experience the reflected appraisals of ourselves that come from other group members. Because we cannot always (or maybe ever) see ourselves as others see us, experiencing how other group members experience us is gold. When it’s working, the group offers us other perspectives that can broaden or expand our own narrow views of ourselves and the world.

Among many of my takeaways is that I loved the use of the word “broaden” to describe what good group counseling can give us. With broadened perspectives we can grow the depth, breadth, and accuracy of our perceptions of ourselves and others.

Here’s the ppt deck for last Tuesday’s class:

group-class-1-2024Download

Until next week,

JSF   

Group counseling, Group therapy, Writing

Teaching Group Counseling: Preparation

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For the first time in seven years, I’m teaching group counseling this semester. This forces me to think about, “What’s the latest scoop on teaching group counseling?” I’ve been reading and talking and gaining information, but if anyone out there has particular insights to share with me, please do.

In my prep, I’ve decided that there’s tons of content out there, in professional journals, books, book chapters, and everywhere else I look. Nevertheless, to break free from the oppression of content, one of my first decisions is to go experiential. This isn’t much different from seven years ago, but my plan is to be even MORE experiential.

Based on previous experiences teaching group, talking with faculty, and talking with students, the Group course is a place with a complex mix of anxiety, vulnerability, and potential conflict. To manage this exciting and challenging mix, I’ve got several plans.

  1. After my infamous “Group is open” anecdote, I will share my philosophy on brain development and counselor skill development. In the Moodle shell, I wrote: “Hey Everybody, Welcome to our group counseling course at U of M. I love group counseling and I love teaching group counseling. More than any other approach, group work requires that we maintain an attitude of acceptance and hold the statements and disclosures that others make with sensitivity and grace. One big goal in this class is for all of us to continue to grow those parts of our brain that makes us excellent listeners. Mostly, we need to let go of other parts of our brain that wants to debate, argue, and express our opinions. I look forward to this adventure and journey with you. See you Tuesday, John SF”
  2. TBH, I’m not sure how my philosophy will fly with students . . . but sharing it fits with Irvin Yalom’s mantra that the group leader is instantly the primary norm setter and role model. Along with my philosophy, I will also disclose some of my anxieties and insecurities. Yes . . . even after 40+ years as a mental health professional, I still feel the creep of imposter anxiety.
  3. Then we’ll circle up and jump into two rounds of experiential introductions. I do two rounds of experiential introductions to give students a chance to “feel” the difference between more structured and less structured group process. I’ve done this before; it feels like a relatively safe, fun, and process-oriented opening.
  4. Then, in the spirit of Yalom’s “self-reflective loop,” we will debrief and debrief some more.
  5. After exiting the experiential introductions, we’ll stay in the circle, review the course syllabus (assignments), and then talk about our planned feedback process. Once, when I asked Allen Ivey for his best advice on learning counseling skills, he said he could summarize his advice in six words: “Practice, practice, practice, feedback, feedback, feedback.” I thought that was a pretty cool answer. You can check out my ideas about feedback on a previous blog post: https://johnsommersflanagan.com/2020/08/18/guidelines-for-giving-and-receiving-feedback/
  6. The last part of class #1 (time permitting) will be me reviewing a few group counseling basics (e.g., group types, group stages, cultural humility, under-confidence, overconfidence, and the wonder and narrowness of the dialectic of lived experience. Should be a blast.

I’m hoping to blog every week about my Group Counseling class and the teaching and learning experience. Of course, that will depend on my time management skills. I’m thinking maybe I’ll coax one of my students into running a psychoeducational group on time management—and then maybe I’ll actually achieve my weekly Group Counseling goals.

Here’s a screenshot of my feedback prompt (aka ppt slide).